Delivery fidelity was high with variable uptake of optional components in a remote multicomponent rehabilitation intervention in intensive care unit survivors (iRehab): a mixed-methods fidelity assessment.

QUESTION: What was the fidelity of a remote multicomponent rehabilitation intervention in intensive care unit survivors (iRehab) across the National Institutes of Health Behavior Change Consortium Treatment Fidelity framework domains (design, training, delivery, receipt and enactment)?

PARTICIPANTS

iRehab participants (n = 429; 231 intervention, 198 standard care); interviews involved 20 intervention participants, 15 standard care participants and six intervention staff.

METHODS

A mixed-methods fidelity assessment was embedded within the process evaluation of a multicentre randomised controlled trial. Quantitative fidelity was assessed using structured checklists, participant-level tracking data and longitudinal monitoring of potential drift. Qualitative interviews explored fidelity processes across domains.

RESULTS

Study design fidelity was maintained, with clear differentiation between the experimental intervention and standard care. Provider training included structured training, competency assessment and ongoing multidisciplinary support. Delivery fidelity was high for one-to-one sessions, with no systematic drift in sampled sessions. Of 231 participants allocated to iRehab, 169 (73%) attended at least five one-to-one appointments. The uptake of optional group-based components was more variable. Qualitative findings indicated participant understanding and engagement, whereas tracking data and participant accounts provided evidence of strategies being applied in daily life.

CONCLUSION

The iRehab intervention was delivered with high delivery fidelity while allowing individualisation to patient needs. For physiotherapists, monitoring of fidelity should extend beyond attendance and exercise prescription to whether patients can independently apply rehabilitation strategies when symptoms, fatigue and everyday demands fluctuate. Defined core components, staff training, staff competency assessment, ongoing support and fidelity monitoring may help support consistent remote delivery.